Journal of evaluation in clinical practice最新文献

{"title":"Reducing Hospitalisations With a Skin and Soft Tissue Infection Clinic","authors":"Tarek Abdelhalim,&nbsp;Naudea Mair,&nbsp;Sherele McGhie,&nbsp;Alon Vaisman,&nbsp;Thomas E. MacMillan","doi":"10.1111/jep.70082","DOIUrl":"https://doi.org/10.1111/jep.70082","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Rationale</h3>\u0000 \u0000 <p>Patients with skin and soft tissue infection are often admitted to hospital despite compelling evidence that many can be managed safely as outpatients. This quality improvement study reports the outcomes of an outpatient skin and soft tissue infection programme implemented at an academic acute-care hospital in Toronto, Canada.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The intervention was an outpatient care pathway for patients with suspected skin and soft tissue infection who may otherwise have required admission to hospital. The programme was implemented within the existing general internal medicine outpatient clinic and primarily involved the addition of part-time advanced practice wound care nurses. The main outcome was the number of hospital inpatient days for skin and soft tissue infection. Data were analysed for 4 years pre-intervention (June 2016–May 2020) and 2 years post-intervention (June 2020–May 2022). Another acute-care hospital in the same network which did not undergo the intervention was included as a control.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>During the 2-year post-intervention period there were 465 clinic visits with the programme (mean of 19/month). The median number of inpatient days for skin and soft tissue infection decreased from 224 per month before the intervention to 148 per month after the intervention (a reduction of 34%). There was no reduction in inpatient days for skin and soft tissue infection at the control site or among all diagnoses at the intervention site.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The implementation of an outpatient skin and soft tissue infection programme was associated with a sustained 34% reduction in inpatient days for skin and soft tissue infection. This study demonstrates the benefits of enhancing an existing outpatient internal medicine clinic through the creation of a streamlined care pathway and adding interdisciplinary expertise.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"31 3","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jep.70082","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143836046","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction to “Fatigue Related COPD From Patient's Perspectives”","authors":"","doi":"10.1111/jep.70102","DOIUrl":"https://doi.org/10.1111/jep.70102","url":null,"abstract":"<p>A. K. Salti, A. Özkaraman, and N. Dudakli, “Fatigue Related COPD From Patient's Perspectives,” <i>Journal of Evaluation in Clinical Practice</i> 31 (2025): e70052.</p><p>The article in question presents original research findings, yet it was incorrectly categorized as a ‘Review Article’ at the time of publication. This correction aims to clarify the misclassification and to affirm that the work should be recognized as an ‘Original Paper.’</p><p>We apologize for this error.</p>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"31 3","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jep.70102","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143836047","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Survey of Health Care Professionals Regarding Transition in Cerebral Palsy in the South East England","authors":"Susie Turner,&nbsp;Charlotte Nash,&nbsp;Jane Goodwin,&nbsp;Johanna Smith,&nbsp;Charlie Fairhurst,&nbsp;Jill Cadwgan","doi":"10.1111/jep.70078","DOIUrl":"https://doi.org/10.1111/jep.70078","url":null,"abstract":"","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"31 3","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143826929","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Governance in Musculoskeletal Care—An Online Cross-Sectional Survey of What Allied Health Professionals Participate in, and What They Value","authors":"James Midgley,&nbsp;Jonathan Thompson,&nbsp;Chris Boyes","doi":"10.1111/jep.70096","DOIUrl":"https://doi.org/10.1111/jep.70096","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Rationale</h3>\u0000 \u0000 <p>Clinical governance (CG) is a systematic approach to improving care quality, ensuring healthcare organisations and professionals are accountable for safe, effective, and continuously advancing practice. Traditionally, CG frameworks follow the ‘seven pillars’ model: risk management, education and training, patient and carer experience, information management, clinical effectiveness, clinical audit, and staff management. However, optimal CG may also require additional elements. Despite its importance, research on CG, and clinicians' views, remains limited, particularly in musculoskeletal (MSK) care where calls for reform are growing.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>To explore the views of NHS MSK Allied Health Professionals (AHPs) on CG, establishing what activities are undertaken and valued. An additional objective was to identify any differences between clinical leads and non-leads.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This exploratory study used an anonymous online cross-sectional survey built with Qualtrics software. Questions were informed by evidence and MSK think-tank discussions, enhancing content validity. The survey evaluated general opinions as well as perspectives on the seven pillars and 23 additional CG activities, including teamwork, culture, and leadership. It was disseminated via social media (X) and Interactive CSP (iCSP) to maximise the response rate. Predominantly ordinal data were analysed using descriptive statistics, with qualitative comments examined using content analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Data from 52 participants were analysed. 96.15% were physiotherapists, 90.38% worked in the NHS, and 53.85% held clinical leadership roles. Respondents viewed CG positively, with 73.08% strongly agreeing it was essential for care quality. Most participated in and valued both the seven pillars and additional activities. No substantial variance was observed between clinical leads and non-leads.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>MSK AHPs in this study strongly supported CG and valued a broader range of activities than the seven pillars model asserts. Findings suggest current approaches may not fully reflect the scope of CG as perceived by clinicians, highlighting the need for more inclusive CG frameworks.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"31 3","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143826946","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Self-Efficacy of General Practitioner Family Physicians in Mental Health Services: A Cross-Sectional Study in Turkey","authors":"Emel Güden,&nbsp;Arda Borlu,&nbsp;Özlem Olguner Eker,&nbsp;Saliha Özsoy,&nbsp;Zeynep Baykan","doi":"10.1111/jep.70097","DOIUrl":"https://doi.org/10.1111/jep.70097","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Rationale&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;The role of primary care physicians in mental health services is increasingly significant. However, there is a lack of research on general practitioners' interest and self-efficacy in providing mental health services.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Aims and Objectives&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;This study aims to assess the interest and self-efficacy of general practitioners in mental health services and to identify their educational needs in this area.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Methods&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;This study employs a cross-sectional design. A total of 461 family physicians are working in primary care health services in Kayseri, Turkey. The study sample included 415 general practitioners who had not received specialist training in family medicine after graduating from medical school. Face-to-face surveys were conducted with 270 general practitioners who agreed to participate in the study. The survey included questions about demographic characteristics, postgraduate training, experiences related to mental health, knowledge of mental health and medication treatment, self-evaluations of self-efficacy in mental health services, and requests for education on the subject.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Results&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;General practitioners reported low self-efficacy in the use and dosage of psychiatric medications (11.9%), but felt more competent in relation to drugs with addictive potential (34.4%). However, they generally perceived their competence in the use and monitoring of psychiatric medications to be low. The area where they felt least competent in managing mental illnesses in primary care was “intervention in suicide.” Their awareness and coordination regarding community mental health centers, as mental health service providers, were found to be low. Overall, general practitioners perceived themselves as inadequately competent in tracking and managing mental illnesses.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusions&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;General practitioners acknowledge that mental health services are a primary care responsibility. However, there is a need to increase their self-efficacy in providing mental health services at the primary care level. Since all participants in this study were public employees, continuing mandatory postgraduate mental health training is crucial. Additionally, strengthening collaboration and coordination mechanisms, as well as providing more effective referrals to community mental health centers, is essential. These","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"31 3","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jep.70097","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143826788","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Monitoring Vital Signs With Continuous Monitoring After Major Gastrointestinal Surgical Procedures: The Patient, Nurse and Physician Perspective","authors":"Elize W. Lockhorst,&nbsp;Milicia van Noordenne,&nbsp;Linda Klouwens,&nbsp;Klaas M. Govaert,&nbsp;Eva de Bruijn,&nbsp;Paul D. Gobardhan,&nbsp;Jennifer M. J. Schreinemakers","doi":"10.1111/jep.70099","DOIUrl":"https://doi.org/10.1111/jep.70099","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Patients undergoing major abdominal surgical procedures are at risk of postoperative complications, requiring early recognition. Clinical deterioration is preceded by changes in vital sings, which are measured three times a day by a nurse. Due to the intermittent measuring, this may result in a delay in the recognition of clinical deterioration. Continuous vital sign monitoring through wireless sensors offers a potential solution for earlier recognition.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>To evaluate user satisfaction of a new wireless monitoring system measuring vital signs continuously, by both patients and healthcare providers.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>A prospective, questionnaire-based study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>From December 2021 to November 2022, user experience questionnaires were administered to patients who underwent major abdominal surgical procedures and received the patch postoperatively. Questionnaires were administered as well to nurses and physicians working on a surgical ward with the patch. Continuous measurements of heart rate, respiratory rate, and temperature were taken using the Sensium wireless patch.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 298 respondents completed the questionnaire, 191 patients, 88 nurses, and 19 physicians. Of the patients, 69% had a positive experience with the patch, and 74% felt safer. Sixty-three percent of the nurses were positive, and 65% had the feeling that they could monitor the patients better this way. Of the physicians, 63% were positive, 32% believed clinical deterioration could be identified earlier.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The use of the Sensium wireless patch for continuous monitoring of vital signs postoperatively was found to be feasible and well-tolerated. Patients, nurses, and physicians reported a positive experience with its use.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"31 3","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jep.70099","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143826928","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient-Centered Care in Chronic Diseases Among Iranian Patients: The Acceptability of Paternalism as a Distinctive Feature","authors":"Mohsen Khosravi,&nbsp;Payam Shojaei,&nbsp;Zahra Kavosi,&nbsp;Ramin Ravangard,&nbsp;Ehsan Shamsi Gooshki,&nbsp;Milad Ahmadi Marzaleh,&nbsp;Sajad Delavari","doi":"10.1111/jep.70073","DOIUrl":"https://doi.org/10.1111/jep.70073","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Rationale</h3>\u0000 \u0000 <p>Research on patient-centeredness in managing chronic diseases like cancer, diabetes, stroke, and heart disorders is gaining prominence. This approach in chronic disease management involves various dimensions and elements, the importance of which has been presented to differ.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims and Objectives</h3>\u0000 \u0000 <p>The present research, carried out in the year 2023, aimed to identify and prioritize existing dimensions and elements of patient-centered care for chronic diseases.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Firstly, multiple databases including the Cochrane Database of Systematic Reviews, Scopus, PubMed and ProQuest were searched. Secondly, 35 chronic patients were interviewed; Finally, a sample of 30 experts familiar with the context was asked to rank the dimensions and elements of patient-centered care using Best-Worst method.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The study identified 6 dimensions and 13 elements of patient-centered care in chronic diseases. The findings indicated that accessibility, quality, education, timeliness and affordability were the five elements that ranked highest in importance for designing and implementing patient-centered care interventions for chronic diseases.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The results presented that Iranian patients with chronic diseases exhibit a positive attitude towards paternalistic behavior and often prefer others to make the best therapeutic decisions on their behalf. Our research revealed that the concept of patient-centered care differs across regions and cultures, highlighting the need for policymakers and researchers to adapt strategies to the specific characteristics of local populations around the globe.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"31 3","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143818773","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Applying Kotter's Change Model to Implement Constructive Alignment in Clinical Teaching Rounds for Service Evaluation","authors":"Rong Liu,&nbsp;Ying Wang,&nbsp;Ronghui Huang,&nbsp;Haina Xing,&nbsp;Meitao Wang,&nbsp;Xinjun Jiang,&nbsp;Xiaofei Wu","doi":"10.1111/jep.70076","DOIUrl":"https://doi.org/10.1111/jep.70076","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Rationale</h3>\u0000 \u0000 <p>Clinical nursing education is crucial for developing competent nursing professionals, and the evolution of teaching methodologies is essential for this development. There is a growing concern about the inadequacy of teaching capabilities among clinical instructors, leading to a significant disparity between students’ theoretical understanding and their practical application in real-world clinical settings. This is a study of the systematic application of Kotter's 8 steps to bring about major changes in the skills, behaviors and motivations of clinical faculty. It is also a study to identify specific patterns of teaching activity that are more to the practice of teaching rounds through the use of the constructive alignment framework.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims and Objectives</h3>\u0000 \u0000 <p>The study aims to develop and implement a clinical faculty development program using constructive alignment (CA) as a framework. Objectives include identifying weaknesses in teaching rounds, conducting a gap analysis based on preprogram self-efficacy surveys, and aligning teaching practices with learning outcomes to improve the effectiveness of clinical education. Kotter's change model has been effectively utilized to navigate and sustain transformation within faculty development initiatives.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>The study used a mixed methods approach, integrating qualitative research through Participatory Action Research with quantitative data from self-efficacy surveys. A group of researchers conducted pre- and post-program self-efficacy surveys, teacher training and interviews over the course of a year. The project was structured into three phases—diagnostic, intervention and evaluation—and we mapped all phases onto Kotter's 8 steps to promoting change. We navigated clinical teachers to conduct teaching rounds under the constructive alignment framework, subsequently employing inductive thematic analysis to meticulously assess the effectiveness of our intervention strategies.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"31 3","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143818774","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Low Back Pain Presentation and Management at the Emergency Department: Differences Between Older Adults Residing in the Community and Aged Care Homes","authors":"Rod Ellem,&nbsp;Quinn Burling,&nbsp;Michel W. Coppieters,&nbsp;James Todd,&nbsp;Rowan Pickering","doi":"10.1111/jep.70088","DOIUrl":"https://doi.org/10.1111/jep.70088","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Rationale</h3>\u0000 \u0000 <p>In healthcare systems without gatekeeper access to Emergency Departments (ED), the number of people presenting for low back pain (LBP) is increasing substantially. Low back pain presentations at the Emergency Department are rarely caused by serious underlying pathology, and management often deviates from practice guidelines. Older adults (≥ 65 years) constitute approximately 30% of all ED LBP presentations. Little is known about differences in presentation characteristics and ED management between older adults from aged care homes and those living in the community.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims and Objectives</h3>\u0000 \u0000 <p>This study aimed to identify differences in presentation and management between people presenting at the ED for LBP from aged care homes versus those residing in the community.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Retrospective observational study of routinely collected healthcare data and chart audits of older adults from aged care homes (<i>N</i> = 64) and age and sex-matched community-dwelling older adults (<i>N</i> = 64) presenting to ED for LBP.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Patients from aged care homes presented with more comorbidities (4 vs. 2), analgesic medication (84% vs. 70%) and polypharmacy (86% vs. 41%) and were more commonly admitted for ongoing analgesia or further diagnostic tests. Community-dwelling older adults were more frequently admitted for Allied Health input. ED administration of opiates was high for both groups (81% aged care; 91% community-dwelling). High rates of lumbar spine medical imaging (61% aged care; 50% community-dwelling) resulted in few acute radiographic findings.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Older patients presenting to ED for LBP receive similar management regardless of their residential status. Hospital management of both groups does not align with current published recommendations namely in respect to imaging and pain medication.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"31 3","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jep.70088","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143818776","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Length of Stay and Its Affecting Factors in a General Hospital of a Multiple Nationality City in Western China","authors":"Li Fang,&nbsp;Wei Yi Yang,&nbsp;Hui Ling Liu,&nbsp;Zi Yang Fang,&nbsp;Qian Li Tang,&nbsp;Jin Hua Wang,&nbsp;Ren Rong Gong","doi":"10.1111/jep.70084","DOIUrl":"https://doi.org/10.1111/jep.70084","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Length of stay (LOS) serves as a key metric for assessing hospital efficiency. However, LOS is complex and multidimensional, and influenced by various factors that require further explorations. The purpose of the present study was to examine factors and their interactions affecting LOS in a general hospital in western China.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This cross-sectional study involved 9631 cases admitted to a tertiary general hospital in Guangxi province, China, from December 2018 to October 2020. LOS and 17 additional variables were collected from the Hospital Information System and integratively analyzed. As a novel factor created in the current study, agreement between admission and discharge departments was evaluated by comparing the admission department with the discharge department. Kruskal–Wallis and Mann–Whitney U tests were used to analyze the relationship of LOS with other variables. Multiple linear regression was employed to identify predictors of LOS.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Variations in LOS were noted among patients based on gender, occupation, patient sources, contact persons, admission types, discharge types, disease severity types or medical payment methods, or patients with or without agreement between admission and discharge departments, the presence of hospital acquired infections (HAI) or antibiotic usages. No significant differences were found related to nationalities, marital statuses, patients with or without agreement between outpatient and discharge diagnoses, or agreement between admission and discharge diagnoses. Moreover, the number of hospitalizations, admission type, discharge type, disease severity type, agreement between admission and discharge departments, HAI, antibiotic usage, and medical payment method significantly predicted LOS, while others did not. The direct effects of agreement between admission and discharge departments on LOS were 86.88% of the total effects.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Factors affecting LOS were observed in the hospital, including agreement between admission and discharge departments. Recommendations should focus on resource allocation and optimization in decision-making to direct patients to suitable departments while improving other critical factors.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"31 3","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143818775","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}